On Aug. 16, WellSpan announced it would eventually drop services in Adams County, but set no timeline. Currently, WellSpan spends at least $1.6 million a year in subsidies for emergency medical services, hospital spokesman Richard Ayers said Thursday.

WellSpan's emergency response, which includes Advanced Life Support and Basic Life Support, operates on what Ayers called the outdated "chase model." This means BLS emergency medical technicians ride in an ambulance and ALS paramedics follow in a separate "chase" vehicle. ALS teams are only dispatch to more serious medical emergencies.

Apart from the inefficiency that comes with sending multiple vehicles to a scene, the system creates billing problems, said WellSpan Senior Vice President Jane Hyde. Only the transporting ambulance company can bill for the call, WellSpan officials said Thursday, although WellSpan does get some money reimbursed when paramedics accompany the patient in the ambulance.

More emergency response organizations across the country are moving toward a system that consolidates ALS and BLS, they said, and WellSpan wants to help create a dialogue to move more the community closer to a more efficient system.

In a letter to area officials Aug. 16, Hyde said WellSpan would be continue their service for a "reasonable amount of time," but would transition to a "community-driven" model for emergency-response services. Gettysburg Borough officials said the letter raised more questions than it answered and decided to draft a letter back.

Thursday, Hyde and Ayers acknowledged they might have done a better job communicating their intentions. But Hyde added they had remained vague in hopes of allowing local governments, fire departments and hospitals to contribute their own ideas. She said she hopes community leaders will work together to create a regionalized and sustainable system of emergency response.

If all goes as planned, the providers in Adams and York Counties will work within their respective areas to form a centralized system.

"I explained it to my employees like a quilt," Hyde said. "The entire area will still be blanketed with emergency care, but there will be less patches on the quilt."

One area of concern has been what WellSpan means by a reasonable amount of time before ending ALS service in Adams County. Thursday, they said the couldn't be any more specific. But Hyde and Ayers vowed WellSpan would not end ALS and BLS services before an adequate replacement program, run by the community, was in place.

"There's a fear that ambulances will be taken off the road and that's a myth," Ayers said. "It would serve us no purpose to harm the current system."

At the same time, Hyde acknowledged, "If we never can get to conversation agreements with community leaders, it is likely that we'd have to say we can no longer be the main provider of emergency health care service.

"However," she stressed, "I think that's very speculative and I am confident it won't come to that."

Ayers said WellSpan would walk hand in hand with community leaders through the transition.

"If there is someone that wants to expand BLS to ALS and the only barrier is a start-up fund, we would be willing to help with that," Ayers said.

Ayers said WellSpan's decision wasn't about the money, but based on changing health-care markets.

When WellSpan began its ALS and BLS program 30 years ago, there were very few organizations offering emergency response in York and Adams counties. However, the number of providers in the both counties has increased, while WellSpan has seen a drop of as much as 50 percent in calls in York County.